Infectious Enterocolitis: Types and Management

Introduction

Inflammation is the body’s natural response to infection or injury. Inflammation is common among both small and large intestine. It can develop among either once at a time, but when the inflammation develops simultaneously, it causes severe complications. Enteritis refers to small intestine inflammation, and colitis refers to large intestine inflammation. This article briefly explains about enterocolitis.

What Is Infective Enterocolitis?

Infective enterocolitis is an infection that causes inflammation in the digestive tract (mainly intestine). Infants, immunocompromised individuals, or HIV (human immunodeficiency virus) patients are highly susceptible to developing infective enterocolitis infection. Infective enterocolitis caused by autoimmune diseases is long-lasting.

How Does Infective Enterocolitis Affect Humans?

Inflammation within the intestines affects the mucosa (inner lining), which causes swelling and tenderness and impacts intestine secretion or absorption. Consequently, influences the person's excretion or digestion.

What Are the Types of Infective Enterocolitis?

• Necrotizing Enterocolitis: The infection develops in ill and prematurely born infants with weak immunity. When exposed to simple bacteria, these patients develop severe illnesses. The disease and inflammation can disrupt the blood supply to the intestine lining, leading to tissue death. However, the exact cause of developing inflammation in the intestine remains unknown.

• Pseudomembranous Enterocolitis: The condition is anointed as antibiotic-associated enterocolitis as the infections develop due to antibiotics—clostridium difficle bacteria people who have recently received antibiotic treatment for other diseases. Most Clostridium bacteria are not affected by the medication, but the antibiotics can affect other intestinal bacteria, which inhibit Clostridium and lets them grow exponentially. The bacteria releases toxins in the intestinal lining. Some develop a severe reaction to the toxins causing enterocolitis. The infection frequently develops in hospitals or nursing homes because of antibiotic use, compromised immunity, and the ability for the infection to remain longer on the hard surfaces.

• Hemorrhagic Enterocolitis: E. coli causes this type of enterocolitis. The bacteria harmlessly live in human intestines. However, a specific type of E.coli known as enterohemorrhagic E.coli produces Shiga toxins that adhere to the intestinal lining, leading to bleeding and inflammation. Those reacting severely to Shiga toxins can develop bleeding in both the intestines and bloody diarrhea. Hemorrhagic enterocolitis is common among older age groups and very young individuals.

• Food-Protein-Induced Enterocolitis: An allergic reaction to food commonly affecting children below two years. An inflammatory immune response develops in the intestinal lining. This type of allergy is non-IgE-mediated and does not produce any antibodies. A delayed reaction develops in the intestine alone, causing enterocolitis symptoms.

• Hirschsprung-Associated Enterocolitis: A dangerous complication caused by a congenital disease of the large intestine (Hirschsprung disease). Babies with this condition have cells missing from a segment of the large intestine. These cells are responsible for muscle contraction and fecal movement through the large intestine. In the intestine segment without cells, the feces do not move and cause blockage. The blockage becomes a breeding site for bacteria. The bacterial infection spreads to both intestines and causes degradation of the intestinal lining, aiding bacterial infiltration.

• Neutropenic Enterocolitis: Enterocolitis develops in individuals suffering from neutropenia. Neutropenia helps protect the body from infections. Individuals with neutropenia develop severe infections leading to enterocolitis. Individuals who have undergone chemotherapy for blood cancers such as leukemia and lymphoma develop neutropenic enterocolitis. Other conditions like HIV (Human Immunodeficiency Virus), AIDS (Acquired Immunodeficiency Virus), and autoimmune diseases also cause neutropenia.

What Causes Infective Enterocolitis?

Most causes of enteritis and colitis lead to enterocolitis. Common causes of developing infective enterocolitis are viral infections like stomach flu, parasites like giardiasis, and bacterial infections like food poisoning. Additionally, overuse of cocaine, alcohol, or over-the-counter medication causes bowel inflammation. Chronic bowel disorders like Crohn’s disease and Celiac disease can also cause infection.

What Are the Infectious Enterocolitis Symptoms?

Along with inflammation, there are symptoms of illness. Signs of infectious enterocolitis are:

• Abdominal pain and cramps.

• Diarrhea or bloody stools.

• Loss of appetite.

• Nausea and vomiting.

• Fever.

• Fatigue.

• Swollen or distended abdomen.

How Is Infectious Enterocolitis Diagnosed?

The enterocolitis is diagnosed based on the signs and symptoms. Blood, stool, and imaging test helps identify the cause of enterocolitis. Abdominal ultrasound and CT (computed tomography) scans help diagnose inflammation and complications in the bowel. Blood and stool test helps analyze the cause of infection.

How Is Infective Enterocolitis Treated?

Treatment depends on the severity and cause of the infection. Most infective enterocolitis is temporarily infectious and is treated with medication. Antibacterial, antiviral, and antiparasitic drugs aid in treatment. Additionally, IV (intravenous) fluids and electrolytes help with vomiting and diarrhea. Corticosteroids help with inflammation, and painkillers help with pain relief.

Severe infective enterocolitis requires the release of fluids, liquid, and gas from the peritoneal cavity and intestine. Intestinal holes, blockages, or necrotic tissue are fixed surgically. A procedure known as colostomy and ileostomy is performed temporarily to redirect food from the bowel while the intestine heals. Nutrition is given intravenously. Chronic enterocolitis is untreatable, but the inflammation is managed with medications.

What Are the Complications of Infective Enterocolitis?

Complications are:

• Sepsis and Shock: Infection can leak from the intestine and enter the peritoneal cavity. If the infection gets into the bloodstream, it can result in blood clots and inflammation throughout the body. Blood clots within the body are a medical emergency as they cause septic shock and multiple organ failure.

• Intestinal Perforation: Severe ulceration, necrosis, or bacterial infiltration can cause a break or tear in the intestinal lining. Therefore, the perforation allows the escape of bacteria from the intestine.

• Cholestasis: Some individuals may not be able to feed and have a build-up of bile and its products. The static bile causes gallstones to develop. If bile collects in the liver and gallstones, it induces inflammation.

• Short Bowel Syndrome: Individuals develop malabsorption when a part of their intestine is removed surgically. The malabsorption of nutrients causes malnutrition.

• Ischemia: Disruption of blood supply to the intestinal lining causes tissue necrosis. To prevent intestinal injury, the necrosed tissue needs to be removed.

• Stricture or Obstruction: Chronic gut lining lesions and inflammation cause tissue scarring. The scar tissues make the gut constricted, making it difficult for food to pass through.

Conclusion

Enterocolitis is the inflammatory condition of both the small and large intestines. The disease is frequent among children and adults. Infants, premature, and immunocompromised patients are at higher risk for developing the infection. Timely diagnosis and treatment can prevent severe complications.